Background Female sex workers (FSW) and people who inject drugs (PWID) are at high risk for HIV infection, with FSW-PWID at even greater risk. HIV-related research often focuses on the primary mode of transmission –sexual or parenteral transmission for FSW and PWID, respectively- with less known on how sex work and injection drug use (IDU) are collectively associated with the risk environment experienced by sex workers. We investigated this relationship among FSW in three Russian cities. Methods In 2011, FSWs (N=754) in Tomsk, Krasnoyarsk, and Kazan were recruited via respondent-driven sampling and completed a survey and rapid HIV screening. Multivariable models evaluated the role of injection history (classified as active: last 6 months, former: prior to last 6 months, and never) with a set of sexual and structural HIV risk outcomes. Results IDU was common: 11% actively injected drugs and 11% were former injectors. HIV infection was most prevalent among active injectors (AOR: 6.7; 95% CI:2.4–18.9) and former injectors (AOR:4.5; 95%CI:1.7–11.6), compared to non-injectors. Some 6–8% of non-injecting FSWs reported recent physical or sexual client violence and 23% police extortion. Compared to these non-injectors, active injecting was associated with unprotected anal sex (AOR: 2.8, 95%CI:1.2–6.4), client violence (AOR: 7.3, 95%CI:2.1–24.7), and police extortion (AOR: 3.0 95%CI:1.5–5.9%). Self-reported sexual and structural risk outcomes were also more prevalent among active compared to former injectors; however, few differences existed between former and non-injectors. Conclusions FSW experience sexual, structural, and HIV risk outcomes and these risks are amplified for actively injecting FSWs. FSW who stopped injecting drugs demonstrated risk profiles closer to those of sex workers who had no history of injection. HIV prevention programs and outreach can provide opportunities to include harm reduction interventions and linkage to treatment for FSW to move FSWs towards lower risk environments.

Introduction Alcohol use is a public health problem in the Russian Federation. This study explored relationships between alcohol use and behavioral risks for HIV transmission among men who have sex with men (MSM) in Moscow, Russia. Methods Alcohol Use Disorder Identification Test scores for 1,367 MSM participating in a cross-sectional survey and HIV testing were categorized to: “abstinence/low use”, “hazardous use”, “harmful use/dependency”. Multiple logistic regression models compared dependent variables for sexual and drug use behaviors across alcohol use strata. Results Hazardous and harmful/dependent alcohol use were significantly associated with high-risk sexual behaviors and drug use. Harmful use/dependency was associated with an increased odds of having more than five male sex partners (last 12 months; AOR:1.69; 95%CI:1.25–2.27), inconsistent condom use during anal intercourse (AOR:2.19; 95%CI:1.61–2.96) and, among those using recreational drugs, injection drug use (last month; AOR:4.38: 95%CI:1.13–17.07) compared to abstinent/low-level users. Harmful/dependent use was marginally associated with HIV infection (AOR:1.48; 95 CI:0.97–2.25). Discussion HIV prevention efforts for MSM in Moscow may benefit from addressing problem alcohol use to mitigate high-risk behaviors.

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Objectives Early diagnosis and treatment of HIV infection is critical to improving clinical outcomes for HIV-infected individuals. We sought to characterise the HIV care continuum and identify correlates of being unaware of one’s HIV infection among MSM in Moscow, Russia. Methods Participants (N=1,376) were recruited via respondent-driven sampling and completed a socio-behavioural survey and HIV testing from 2010–2013. Sample and population estimates were calculated for key steps along the HIV care continuum for HIV-infected MSM and logistic regression methods were utilized to examine correlates of being unaware of HIV infection. Results 15.6% (184/1177; population estimate:11.6%; 95%CI:8.5–14.7%) of participants were HIV infected. Of these, only 23.4% (43/184; population estimate:13.2; 95%CI:11.0–15.4) were previously aware of their infection, 8.7% (16/184 population estimate:4.7; 95%CI:1.0–8.5) were on ART, and 4.4% (8/164; population estimate:3.0; 95%CI:0.3 – 5.6) reported an undetectable viral load. Bisexual identity (reference: homosexual; AOR:3.69; 95%CI:1.19–11.43), having ≥5 sexual partners in the last 6 months (reference: ≤1; AOR:4.23; 95%CI:1.17–15.28), and employment HIV testing requirements (reference: no; AOR:15.43; 95%CI:1.62–147.01) were associated with being unaware of one’s HIV infection. HIV testing in a specialized facility (reference: private; AOR: 0.06; 95%CI: 0.01–0.53) and testing ≥2 times in the last 12 months (reference: none; AOR:0.17; 95%CI:0.04–0.73) were inversely associated with being unaware of HIV infection. Conclusion There is a steep gradient along the HIV care continuum for Moscow-based MSM beginning with low awareness of HIV infection. Efforts that improve access to acceptable HIV testing strategies, such as alternative testing facilities, and linkage to care are needed for key populations.

Objective To determine the prevalence of, and factors associated with, use of non-barrier contraception (intrauterine device, hormonal contraceptives, and female sterilization) among female sex workers (FSWs) in three Russian cities. Methods A secondary analysis of data from a cross-sectional survey of FSWs aged 18 years and older from Kazan, Krasnoyarsk, and Tomsk was undertaken. Participants had completed a one-time computer-based survey in 2011. Among the 708 with a current contraceptive need, logistic regression was used to evaluate factors associated with use of non-barrier contraceptives. Results Use of non-barrier contraceptives was reported by 237 (33.5%) FSWs. Use of non-barrier contraceptives was associated with being in sex work longer (≥4 years vs <1 year: adjusted odds ratio [AOR] 4.70; 95% confidence interval [CI] 1.51–14.66) and having a non-paying partner (AOR 2.02; 95% CI 1.32–3.11). Odds of non-barrier contraception were reduced among FSWs who had ever worked with a pimp/momka (AOR 0.46; 95% CI 0.24–0.87), who had experienced recent client-perpetrated violence (AOR 0.19; 95% CI 0.07–0.52), or reporting consistent condom use (AOR 0.30; 95% CI 0.16–0.54). Only 13 (5.5%) of the 237 FSWs using non-barrier contraception reported consistent condom use. Conclusion Only one-third reported use of non-barrier contraception, suggesting substantial unmet contraceptive needs. FSWs are an important target population for family planning, reproductive health counseling, and care.